This pilot trial aims to evaluate the effectiveness of chat-based instant messaging support in preventing smoking relapse in recent tobacco abstainers.
Smoking cessation is one of the most cost-effective health interventions, which can add up to
10 years of life expectancy (Jha et al., 2013). However, it is very difficult to quit smoking
because of the addictive effect of nicotine presents in tobacco products, and smokers
typically make multiple attempts before successfully quit smoking. Providing evidence-based
treatment could substantially increase the chance of successful quitting.
The Coronavirus Disease 2019 (COVID-19) provided new opportunities and challenges in
promoting smoking cessation. A growing literature has shown that smoking is linked to poor
progression of COVID-19 (Patanavanich & Glantz, 2020), which can be a new warning for
motivating smokers to quit smoking. However, social distancing measures and increased stress
and anxiety related to fear of contracting COVID-19 may increase the risk of smoking relapse
in people who recently quit smoking (Patwardhan, 2020). There are also misinformation or
unproven claims that smoking can protect against COVID-19. The social distancing measures
also become a barrier for smokers who are interested in quitting to receive treatment from
smoking cessation clinics. Therefore, implementing new interventions that can address the
challenges in the context of the COVID-19 pandemic is needed.
Advance in mobile technologies provides a new avenue for delivering smoking cessation
support. A qualitative interview of 21 current smokers in Hong Kong has found that mobile
instant messaging app (e.g., WhatsApp) is an acceptable and feasible platform for providing
chat support for smoking cessation (Luk et al., 2019). Chat-based support allows a registered
nurse or trained counsellor to interact with a smoker individually through mobile instant
messaging apps (e.g., WhatsApp and WeChat) and provide real-time, continuous, and
personalized smoking cessation information and advice. A randomised trial of 1185 smokers
found that the chat-based intervention integrated with brief intervention was effective in
increasing smoking cessation (Wang et al., 2019). The trial also provided initial evidence
that the intervention can be delivered as a stand-alone treatment or in combination with use
of existing cessation treatment, to increase the chance of successful quitting. This study
aims to adapt the chat intervention for smoking relapse prevention and evaluate its
feasibility and effectiveness in recent tobacco abstainers enrolled in a clinic-based smoking
cessation service in Hong Kong.
Behavioral: Chat-based instant messaging support
Subjects will receive personalised instant messaging support for 12 weeks after baseline, address the five problems that contributed to smoking relapse:
(1) lack of support for cessation, (2) negative mood or depression, (3) strong or prolonged withdrawal symptoms, (4) weight gain, and (5) smoking lapses. Updated information about the negative effect of smoking on risk of COVID-19 infection and prognosis will also be delivered.
Behavioral: SMS message support
Subjects will receive regular SMS on generic smoking cessation for 3 months.
Behavioral: Self-help booklet
Subjects will receive a standard self-help booklet on smoking relapse prevention.
Inclusion Criteria:
- Hong Kong residents aged 18 years or older
- Enrolled in a smoking cessation programme under Tung Wah Group of Hospitals Integrated
Centre on Smoking Cessation
- Daily tobacco use before service intake
- Not using any tobacco product for 3 to 30 days
- Own a mobile phone with a mobile instant messaging app (WhatsApp or WeChat) installed
- Able to communicate in Chinese (Cantonese or Mandarin)
Exclusion Criteria:
- Subjects with communication barriers owing to physical or cognitive conditions will be
excluded.
Tung Wah Group of Hospitals Integrated Centre on Smoking Cessation
Hong Kong, Hong Kong
Tzu Tsun Luk, PhD, RN, Principal Investigator
The University of Hong Kong